| NPI | 1437364791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ D19407) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01940700) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |