| NPI | 1669589842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22D101802700) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 042690) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |