| NPI | 1093062002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS039106) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02513400) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2023-02-07 |