| NPI | 1073708038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 040209-2) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22D102490000) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2013-04-02 |