| NPI | 1184817652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ di23194) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02319400) |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2016-12-15 |