| NPI | 1538575352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02599200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11209) |
| 1223G0001X Dentist, General Practice (Licence: PA DS039936) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2015-07-17 |