| NPI | 1801201223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058212-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02573200) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2015-10-09 |