| NPI | 1306487160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205235) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02822400) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2023-12-13 |