| NPI | 1952501132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01959500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D01959503) |
| 1223G0001X Dentist, General Practice (Licence: NY 050504-1) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2010-08-12 |