| NPI | 1427188945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26847) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI21517) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2026-02-12 |