| NPI | 1346251675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22D101873500) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D101873500) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-05-08 |