| NPI | 1205972809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02348601) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052738) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2010-02-25 |