| NPI | 1780654947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 14655) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 38634) |
| 122300000X Dentist (Licence: FL 10236) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-09 |