| NPI | 1932436359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01608300) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI01608300) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NJ 22-DI01608300) | |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2019-02-18 |