| NPI | 1992808547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02086401) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ DI02086400) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2024-07-16 |