| NPI | 1891082012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 057097) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02479900) |
| 1223G0001X Dentist, General Practice (Licence: PA DS038765) | |
| 1223G0001X Dentist, General Practice (Licence: CT 10580) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2014-02-26 |