| NPI | 1558574855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053487-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02298401) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2008-05-10 |