| NPI | 1306196480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS042494) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02506000) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2026-07-11 |