| NPI | 1265461420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02295200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 048956-1) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2010-05-05 |