| NPI | 1669810131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI025568) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414039) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2016-01-03 |