| NPI | 1023228889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS037006) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21477) |
| 122300000X Dentist (Licence: NJ 22DI02344800) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |