| NPI | 1710588066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 062000) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02746900) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2021-09-17 |