| NPI | 1912304684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 10020) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02589000) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2016-04-15 |