| NPI | 1720129919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 17428) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057157-1) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2019-10-16 |