| NPI | 1922449792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02541100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056972-1) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2021-08-20 |