| NPI | 1346584299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DS038801) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI02532800) |
| 122300000X Dentist (Licence: PA DS038801) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NJ DI02532800) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2013-05-17 |