| NPI | 1386972834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS038209) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22d102428000) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2010-06-29 |