| NPI | 1295469922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS0043921) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02906500) |
| Enumeration Date | 2022-07-09 |
| Last Update Date | 2023-02-02 |