| NPI | 1477042513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 060712) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02742200) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2021-11-07 |