| NPI | 1295868958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN13404) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D101516500) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |