| NPI | 1639322027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02351200) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054044-1) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2013-05-23 |