| NPI | 1043216435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 039997) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 039997) |
| 122300000X Dentist (Licence: NJ 22DIO1606400) | |
| 122300000X Dentist (Licence: CT 7066) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 7006) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NJ 220101606400) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2013-06-19 |