| NPI | 1447323753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 50-052742) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22D1017800) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2018-04-23 |