| NPI | 1508828443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DS041586) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI17383) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2023-02-09 |