| NPI | 1851690184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056328) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02464400) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2018-04-13 |