| NPI | 1871797803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI02237300) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 053508) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2007-09-17 |