| NPI | 1366313280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03122000) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS045429) |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-09-15 |