| NPI | 1215503347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS043947) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02830000) |
| Enumeration Date | 2021-05-30 |
| Last Update Date | 2024-04-12 |