| NPI | 1316652480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 18043) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 2DDI03071900) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2025-02-04 |