| NPI | 1306808068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DI02276600) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22766) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2012-04-18 |