| NPI | 1700865557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02441000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 19502) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2010-06-09 |