| NPI | 1710211388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DD101628200) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: NJ 3554) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2009-09-29 |