| NPI | 1922366517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02543300) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056959-1) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2016-02-07 |