| NPI | 1306849898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI022697) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050821-1) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2007-10-26 |