| NPI | 1043434707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS035177) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02441601) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2010-07-20 |