| NPI | 1356488043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 19402) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS029422-L) |
| 1223G0001X Dentist, General Practice (Licence: NC 8344) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-08 |