| NPI | 1295176329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058338-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02598900) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2018-05-09 |