| NPI | 1831347681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01737900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI017379) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2023-04-25 |