| NPI | 1932240645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26674) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI014140000) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-04-05 |