| NPI | 1982670519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI18597) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 046537) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2013-01-17 |