| NPI | 1326324021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14848) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02484300) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2012-07-05 |