| NPI | 1235264227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NJ 3161) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: NJ 22DI01294600) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |