| NPI | 1831362342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01976200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN 18918-1) |
| 1223G0001X Dentist, General Practice (Licence: NY 5519912) | |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2008-04-04 |