| NPI | 1043486830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 043755-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01797200) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2015-02-19 |