| NPI | 1740298892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ DI02140700) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 049481) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2022-07-21 |