| NPI | 1639386147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 13633) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 050709) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2012-10-15 |