| NPI | 1083790877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS031282L) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02399301) |
| 122300000X Dentist (Licence: NJ 22DI02399300) | |
| 1223P0700X Dentist Prosthodontics (Licence: PA DS031282L) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2025-07-29 |