| NPI | 1992854673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DJ02278500) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 052245) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2012-08-07 |