| NPI | 1861177768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03142900) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS045592) |
| 1223P0300X Dentist, Periodontics (Licence: NJ 07650) | |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2026-07-30 |