| NPI | 1750690467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02423600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055223-1) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2016-07-10 |