| NPI | 1265641559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN13693) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 18627) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2014-10-22 |