| NPI | 1437291127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01118000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS-019757-L) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2008-01-15 |