| NPI | 1558058362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI03003700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 064153) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2025-06-03 |