| NPI | 1952668782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 26802) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 8586) |
| 122300000X Dentist (Licence: FL 8659) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |