| NPI | 1992707897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22D102282500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 8260) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-09-11 |