| NPI | 1538540901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI2741700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021583) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2019-12-14 |