| NPI | 1780814129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI1319300) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01319300) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2025-08-21 |