| NPI | 1508192063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 054655-1) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02424600) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 10122) | |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2009-10-19 |