| NPI | 1326677204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DIO2894100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DIO2894101) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-01-12 |