| NPI | 1669668562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 041756) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NJ 10980) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY 041756) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2013-04-12 |