| NPI | 1427277698 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DIO1895600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01895600) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2019-04-01 |