| NPI | 1891367967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02879200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 26147) |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2024-01-10 |