| NPI | 1356303044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 25MA07730100) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ DI218860) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-05-28 |