| NPI | 1700092285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 050025) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02414200) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2010-05-10 |