| NPI | 1518391960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 058249-01) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02548100) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2021-05-26 |