| NPI | 1134272719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02194700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050126-1) |
| 1223G0001X Dentist, General Practice (Licence: MD 13122) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2015-11-23 |