| NPI | 1336532712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: PA DS040281) |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist (Licence: NJ 22DI02659400) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2018-05-02 |