| NPI | 1578679429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ 22DI02313900) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02313901) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-08 |