| NPI | 1679624084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02285500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050012) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2013-03-04 |