| NPI | 1083832307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS 026508L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DIO1688700) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2011-09-20 |