| NPI | 1306999891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN0014954) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02039100) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2007-07-08 |