| NPI | 1548391303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI17929) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 043578-1) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2021-01-05 |