| NPI | 1396852679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 17226) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 42983) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2014-06-16 |