| NPI | 1154446318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DI 17684) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029675) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2013-12-04 |