| NPI | 1487437968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044160) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03019500) |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2024-04-29 |