| NPI | 1083714216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22D102309902) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D102309901) |
| 1223G0001X Dentist, General Practice (Licence: NY 50 052077) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2015-12-11 |