| NPI | 1245547603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS037579) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ DI24499) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2020-10-08 |