| NPI | 1497029268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 047219) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02521300) |
| Enumeration Date | 2012-02-26 |
| Last Update Date | 2014-10-01 |