| NPI | 1518135466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056252-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02285800) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2018-10-24 |