| NPI | 1548570674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14480) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055019) |
| 122300000X Dentist (Licence: NJ 22D102449600) | |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2015-09-28 |