| NPI | 1437122025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 12118) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN20964) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2021-06-30 |