| NPI | 1730418211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NJ 6196) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02427100) |
| Enumeration Date | 2009-12-13 |
| Last Update Date | 2016-10-05 |