| NPI | 1164649489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 048081) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02171400) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2024-07-09 |