| NPI | 1275798316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 0446411) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ D1018602) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2008-07-28 |