| NPI | 1841529211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 045566) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02198400) |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2009-12-15 |