| NPI | 1770599169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 050238) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI 20881) |
| 122300000X Dentist (Licence: MD 12594) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-09 |