| NPI | 1679995955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI19751) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01975100) |
| 122300000X Dentist (Licence: NY 047461-1) | |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |