| NPI | 1679885958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02415100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02415100) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2022-09-23 |