| NPI | 1265665020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS038065) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02419100) |
| 1223G0001X Dentist General Practice (Licence: DC DEN1000835) | |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2010-02-25 |