| NPI | 1386985281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02547000) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057714) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2014-12-30 |