| NPI | 1336127778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS023057L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 08841) |
| 1223G0001X Dentist, General Practice (Licence: NJ 13849) | |
| 1223G0001X Dentist, General Practice (Licence: MA 16773) | |
| 1223G0001X Dentist, General Practice (Licence: MD 8841) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN16773) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2018-01-31 |