| NPI | 1699882357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 15992) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 040794-1) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-06-19 |