| NPI | 1598745069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 052569) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02306500) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2007-07-08 |