| NPI | 1497811228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01438200) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NJ 22DI01438200) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2012-02-25 |