| NPI | 1427671247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044570) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 013323) |
| 122300000X Dentist (Licence: NJ 22DI02901400) | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2024-06-19 |