| NPI | 1790568889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22D103042600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.034580) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-10-06 |