| NPI | 1730397647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02151900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02151903) |
| 1223G0001X Dentist, General Practice (Licence: NJ 21519) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2025-05-05 |