| NPI | 1356593776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 045199) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DIO1893300) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2023-12-09 |