| NPI | 1003912791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DI01790300) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS029630L) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |