| NPI | 1912296898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02586300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056094) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2014-10-07 |