| NPI | 1215389093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 061115) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02799500) |
| 1223G0001X Dentist, General Practice (Licence: PA DS040911) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2020-08-02 |