| NPI | 1184293946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044027) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 063238) |
| 122300000X Dentist (Licence: NJ 22DI02990100) | |
| 1223G0001X Dentist, General Practice (Licence: CA 106293) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-01-02 |