| NPI | 1326052481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ 1432600) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS023781L) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-04-16 |