| NPI | 1356343438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS019999L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D101206200) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2007-07-08 |