| NPI | 1114363736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02640300) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS041057) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 058450) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2019-03-12 |