| NPI | 1518008093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS024064L) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI01467000) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2008-05-12 |