| NPI | 1689181547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02687100) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NC 11723) |
| Enumeration Date | 2018-01-01 |
| Last Update Date | 2023-08-11 |