| NPI | 1518351964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02778000) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030599) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2020-03-16 |