| NPI | 1639390420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 049374) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02300300) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |