| NPI | 1033102777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI01270800) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS021938) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2023-01-06 |