| NPI | 1558552901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 59275) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DIO2432700) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2020-01-28 |