| NPI | 1487073888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0001359) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02570900) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2015-07-08 |