| NPI | 1396879532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 14077) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 037550-1) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-08 |