| NPI | 1558785410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058064) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02614000) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2020-01-29 |