| NPI | 1508918541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 052001) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02336500) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-08 |