| NPI | 1245496421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02561600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054011) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2016-05-10 |