| NPI | 1417008988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 044251) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI019048) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-08 |