| NPI | 1922051382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI 09831) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 028556-1) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2014-02-28 |