| NPI | 1740252949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 030952) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ D11966) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2007-07-08 |