| NPI | 1134555667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DJ02489100) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 50056960) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2018-11-27 |