| NPI | 1104917392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ D1-19550) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 19550) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2009-08-31 |