| NPI | 1730205691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 051193-1) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02274200) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2019-01-16 |