| NPI | 1205994738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 049486-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102142700) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2012-08-16 |