| NPI | 1770909103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02638600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 057970-1) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2016-07-19 |