| NPI | 1720186745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 0558311) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ DI20280) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2012-12-26 |