| NPI | 1740479443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 110070) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01799000) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2025-01-03 |