| NPI | 1316623895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN30724) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI03112200) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-06-03 |