| NPI | 1528371507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02571300) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038160) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02571301) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2014-10-30 |