| NPI | 1194821421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22879) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050481) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2011-12-20 |