| NPI | 1801049234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DIO1785000) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ NJ-3807) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2008-10-29 |