| NPI | 1982605952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ DI019452) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 043124) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-03-31 |