| NPI | 1386727055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS026574L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI017168) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-01-25 |