| NPI | 1194902411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS037285) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02367100) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2009-07-13 |