| NPI | 1194125039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 059001) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02572300) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2021-01-19 |