| NPI | 1528305919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02421400) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 010898) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 056530) | |
| Enumeration Date | 2013-01-06 |
| Last Update Date | 2017-11-14 |