| NPI | 1356751481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02598200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058337) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1856819) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2016-02-17 |