| NPI | 1639266505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 18628) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D100S52800) |
| 122300000X Dentist (Licence: CT 002633) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |