| NPI | 1376893552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02523700) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28303) |
| 122300000X Dentist (Licence: PA 039381) | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2014-04-24 |