| NPI | 1659677508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 049431) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02148900) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2011-02-09 |