| NPI | 1336693753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02921300) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10581) |
| 1223G0001X Dentist General Practice (Licence: PA DS041025) | |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2022-09-22 |