| NPI | 1629278668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053105) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22di02349500) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2014-08-27 |