| NPI | 1013790138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044378) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02992900) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-06-14 |