| NPI | 1740356435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NJ 8422) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NJ 2047) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |