| NPI | 1053543629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 34489) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 12268) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2009-08-17 |