| NPI | 1508153107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02531500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056164) |
| 1223G0001X Dentist, General Practice (Licence: FL DN19521) | |
| Enumeration Date | 2011-07-02 |
| Last Update Date | 2015-10-06 |