| NPI | 1831477645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02556100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA 38836) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2022-06-30 |