| NPI | 1356408470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22di02185900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 049148) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-07-16 |