| NPI | 1376801951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02531800) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056916) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2013-10-10 |