| NPI | 1033447602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI 02380200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051078) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2009-11-19 |