| NPI | 1487035671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ 22DI02630700) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS040705) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2019-04-13 |