| NPI | 1427241033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 045868) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02336900) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2016-07-05 |