| NPI | 1417952714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02727300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 049435) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-11-07 |