| NPI | 1023071263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS030654L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 20487) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2010-04-12 |