| NPI | 1881919728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 00055621) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NJ 22DI02480400) |
| 122300000X Dentist (Licence: NY 00055621) | |
| 122300000X Dentist (Licence: NJ 22DI02480400) | |
| Enumeration Date | 2010-04-04 |
| Last Update Date | 2015-03-24 |