| NPI | 1730263732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13938) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01256900) |
| 1223G0001X Dentist, General Practice (Licence: NY 035180) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2016-10-19 |