| NPI | 1225008428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI011668) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS020535L) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-03-07 |