| NPI | 1144492984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22di02342800) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052148) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2018-04-10 |