| NPI | 1952737835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01606900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01606901) |
| 122300000X Dentist (Licence: NJ 22DI01606902) | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2016-01-25 |