| NPI | 1851516926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ DI18340) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI01834000) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2022-10-17 |