| NPI | 1437292752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ MA61656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA61656) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |