| NPI | 1790821262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02263800) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051567-1) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-11-21 |