| NPI | 1356534184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DIO12283) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI012283) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |