| NPI | 1316247497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02454700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038503) |
| Enumeration Date | 2010-10-23 |
| Last Update Date | 2019-07-02 |