| NPI | 1972675973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 048386-1) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI020912) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |