| NPI | 1447446877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 052153) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ DI02382700) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2008-08-15 |