| NPI | 1902023807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 08867) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 030026) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2017-01-31 |