| NPI | 1255743159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 07007) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02593600) |
| 207L00000X Anesthesiology (Licence: NJ 22DA00799) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2026-01-06 |