| NPI | 1427534346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9266) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02723700) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2020-06-16 |