| NPI | 1427316223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02630100) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 204E00000X) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2019-08-27 |