| NPI | 1003048844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02144900) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 049142) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2015-05-18 |