| NPI | 1508019597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS035449) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02205300) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2008-11-04 |