| NPI | 1962438911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 14372) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D101047801) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-01-08 |