| NPI | 1639241532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NJ 22D101532900) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 038072) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2014-03-03 |