| NPI | 1326206970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 20012) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02406400) |
| 1223G0001X Dentist, General Practice (Licence: PA DS031451L) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2014-04-28 |