| NPI | 1770276503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02997900) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044082) |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2024-09-13 |