| NPI | 1811567472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02934700) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 26076) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2024-06-16 |