| NPI | 1326192378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02401700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050618) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-02-17 |