| NPI | 1346458965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 042981) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01882200) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |