| NPI | 1679663819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 050349) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D101349400) |
| 1223G0001X Dentist, General Practice (Licence: PA DS022838) | |
| 1223G0001X Dentist, General Practice (Licence: CA 43651) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |