| NPI | 1689703910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01263600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DIo1263600) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2007-07-08 |