| NPI | 1427671304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02785200) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02785200) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2024-12-05 |