| NPI | 1376923482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02626300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 011630) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-01-07 |