| NPI | 1730396029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI01695900) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ D1016959) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-07-21 |