| NPI | 1295929362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02406700) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053710) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2015-05-19 |