| NPI | 1275729956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054638) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI02323700) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2009-12-01 |