| NPI | 1528184082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI 20861) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 15370) |
| 122300000X Dentist (Licence: NY 054615-1) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2011-12-05 |