| NPI | 1346598612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056213) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02503300) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2012-08-16 |