| NPI | 1831403385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 055234) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02443900) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2020-02-07 |