| NPI | 1538380761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02436900) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55486) |
| 1223G0001X Dentist, General Practice (Licence: NY 048591) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2010-12-08 |