| NPI | 1003212028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02620100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058184) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2015-12-28 |