| NPI | 1578710752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02375300) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054844-1) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2010-10-01 |