| NPI | 1326344219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 055839) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02447800) |
| Enumeration Date | 2011-02-10 |
| Last Update Date | 2013-12-11 |