| NPI | 1730108580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 038838) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D101545700) |
| 1223G0001X Dentist, General Practice (Licence: CA 32946) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |