| NPI | 1457361610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7742) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 044786) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI01862900) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2007-07-08 |