| NPI | 1669648903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02352700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 22041) |
| 1223G0001X Dentist, General Practice (Licence: CT 009808) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-05-06 |