| NPI | 1467653881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 048949-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01913101) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-04-06 |