| NPI | 1205049707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02350900) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 053649) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2017-01-05 |