| NPI | 1871832774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02565000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 057487) |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2020-07-17 |