| NPI | 1881009371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02832700) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040030) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-06-24 |