| NPI | 1487052288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 06854) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02587500) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2025-03-05 |