| NPI | 1669830691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 059395) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02659800) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2018-07-14 |