| NPI | 1285981928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 056278) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02504900) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2012-08-13 |