| NPI | 1366971285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS041330) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DR03097) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2017-12-22 |