| NPI | 1053448928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22D100918700) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 029107) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2010-11-01 |