| NPI | 1275012841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13052) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02703800) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2023-08-03 |