| NPI | 1851946313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02894800) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 7242) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2024-03-06 |