| NPI | 1295797983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: PA DS028154-L) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NJ 20169) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2007-07-08 |