| NPI | 1376717595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI00851000) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 2654) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2008-04-18 |