| NPI | 1144424292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 052860) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DIO2344900) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2018-01-26 |