| NPI | 1477990182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA ds041513) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22di02956000) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2024-10-03 |