| NPI | 1265592976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 0029305) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI00898400) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2012-03-08 |