| NPI | 1851667414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056883) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102514800) |
| 122300000X Dentist (Licence: AL 6053C1) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2015-09-18 |