| NPI | 1235294646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS045009) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01739900) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2025-08-19 |