| NPI | 1801063854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ DI02313300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI02313300) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2011-05-18 |