| NPI | 1043678659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 059422-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02628400) |
| 1223P0300X Dentist, Periodontics (Licence: NJ 06701) | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2018-12-03 |