| NPI | 1447690136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 057654) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02541800) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2016-10-18 |