| NPI | 1194101527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 058130) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058130) |
| 122300000X Dentist (Licence: NJ 22DI02550500) | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2016-11-08 |