| NPI | 1598786410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02240700) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 048580) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2007-07-08 |