| NPI | 1134552920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01219000) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 034419-1) |
| 122300000X Dentist (Licence: NJ 12190) | |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |