| NPI | 1104192863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02518201) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2016-06-10 |