| NPI | 1134132301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 049154) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 220102139701) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-12-30 |