| NPI | 1467701599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02480100) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 055804-01) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2023-09-13 |