| NPI | 1821328766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02754200) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052819) |
| Enumeration Date | 2009-12-26 |
| Last Update Date | 2024-07-01 |