| NPI | 1538418108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS039173) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02509300) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2020-01-11 |