| NPI | 1255596987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 055287) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02424900) |
| 122300000X Dentist (Licence: CA 57269) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2015-03-30 |