| NPI | 1154400463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS036087) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02294500) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2010-08-12 |