| NPI | 1093807976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 12474) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 3047) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2007-07-08 |