| NPI | 1255415469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 08839) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI18862) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-10-09 |