| NPI | 1114551660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044719) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03051300) |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2024-07-23 |