| NPI | 1679579080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01910100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 046293-1) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2026-08-20 |