| NPI | 1346235397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI0211300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 048768) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2007-07-08 |