| NPI | 1760517841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY D051800) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02303200) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2009-10-22 |