| NPI | 1235257684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 21296) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02129600) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2018-06-01 |