| NPI | 1699874453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02299200) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 03622) |
| 122300000X Dentist (Licence: MA 21826) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2015-04-09 |