| NPI | 1497051379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS038506) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02452300) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2012-09-04 |