| NPI | 1447600267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 59289) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02659101) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-10-06 |