| NPI | 1780874651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 053792) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI02348400) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2016-03-04 |