| NPI | 1356591903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS038055) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 052540) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02374300) | |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2009-11-16 |