| NPI | 1487601613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI20448) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 046379-1) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2019-07-26 |