| NPI | 1750362232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 009912) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ DI01308801) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2019-02-14 |