| NPI | 1548279482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI01288301) |
| Additional Taxonomies | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: NJ DI12883) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2024-05-13 |