| NPI | 1346658192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN016098) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02577300) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2022-06-02 |