| NPI | 1972775674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 040609-1) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22D100960500) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2018-03-17 |