| NPI | 1437200862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 14291) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS023923L) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2020-10-24 |