| NPI | 1639227101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ NJ11072) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01107200) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2025-05-27 |