| NPI | 1205914322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NJ 22D101115000) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: PA DS018944L) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |