| NPI | 1063439636 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01537702) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI015377-01) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-11-18 |