| NPI | 1831327907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 11460) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 11460) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2009-06-29 |