| NPI | 1518133149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY NY-047958) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NJ 22DI02088500) |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2015-05-18 |