| NPI | 1467402107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 034568) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI19425) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2012-08-16 |