| NPI | 1649041641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN31216) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02986900) |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2025-12-31 |