| NPI | 1790945038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02373200) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02373200) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |