| NPI | 1134458334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02553800) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038125) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2016-02-22 |