| NPI | 1174679740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 051532) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02280100) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-05-15 |