| NPI | 1770061020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23321) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02718800) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2024-02-06 |