| NPI | 1851596803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 054210-1) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22di02418800) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2013-04-17 |