| NPI | 1700026085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 06174) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22di02390500) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2013-04-12 |