| NPI | 1700143591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 056265) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02498300) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2023-06-15 |