| NPI | 1487644456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 220102233400) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 047203) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2012-10-05 |