| NPI | 1801915590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01647300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 039483) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2010-07-08 |