| NPI | 1255444048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 038125) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02117200) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2016-03-31 |