| NPI | 1730416900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 055244) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02424400) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2011-04-13 |