| NPI | 1760556138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NJ 22DI01947900) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 043610) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2018-02-28 |