| NPI | 1578754719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 9688) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 030542) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-04-17 |