| NPI | 1295277374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS041044) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02651100) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2022-07-21 |