| NPI | 1114184942 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01461100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 037955-1) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |