| NPI | 1205899424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS038181) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 20911) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2010-03-17 |