| NPI | 1083715734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02314900) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051169) |
| 1223P0700X Dentist, Prosthodontics (Licence: PA DS036867) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-12-04 |