| NPI | 1346393576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01440100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS023817L) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2015-09-14 |