| NPI | 1720162225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 028443) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ D1009754) |
| 122300000X Dentist (Licence: MD 5294) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2008-05-30 |