| NPI | 1356311302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI0106000) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 10690) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2012-06-28 |