| NPI | 1962533158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ di017945) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 044018-1) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2009-01-29 |