| NPI | 1336700046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02761100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS042225) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2019-06-24 |