| NPI | 1114954492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS041483) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 060077-1) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02938400) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2025-11-04 |