| NPI | 1164515458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ DI019380) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 046104) |
| Enumeration Date | 2006-10-01 |
| Last Update Date | 2014-03-19 |