| NPI | 1508354267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 07483) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02789100) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 064216) | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2025-05-23 |