| NPI | 1568650588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D9824) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02178000) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2019-11-05 |