| NPI | 1477808707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI03058300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 103695) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2024-10-16 |