| NPI | 1467966572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12623) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9881) |
| 122300000X Dentist (Licence: NJ 22DI02685800) | |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2024-05-14 |