| NPI | 1831644681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02647500) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22174) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2016-10-04 |