| NPI | 1538417332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010859) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02511900) |
| 122300000X Dentist (Licence: CT 10859) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2012-10-16 |