| NPI | 1497131189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NJ 22DA00702) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02615000) |
| 122300000X Dentist (Licence: PA DS040566) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DA031740) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2022-04-20 |