| NPI | 1518113240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22D102133002) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS031104L) |
| 122300000X Dentist (Licence: NY 048521) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2008-08-13 |