| NPI | 1568695724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20981) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02422900) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2016-12-13 |