| NPI | 1285707273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ ZZD102055600) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ ZSMA07810100) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2024-05-13 |