| NPI | 1497887897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02347800) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036851) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2024-04-30 |