| NPI | 1417008996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS036428) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02303400) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2007-07-08 |