| NPI | 1558581108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS035501) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02256300) |
| 1223G0001X Dentist, General Practice (Licence: MO 2000164228) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2014-09-04 |