| NPI | 1881071603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058660) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02640000) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2022-07-21 |