| NPI | 1265556773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ DI 18681) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 044177) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-06-02 |