| NPI | 1194812974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: PA DS043891) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02212900) |
| 1223G0001X Dentist, General Practice (Licence: NJ DI022129) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2024-01-09 |