| NPI | 1548471782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 035173) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DIO1953900) |
| Enumeration Date | 2007-05-26 |
| Last Update Date | 2007-07-08 |