| NPI | 1306038922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI012054) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ 1223P0700X) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2008-01-28 |