| NPI | 1568084663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 17929) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02819100) |
| 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02819100) | |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2023-10-20 |