| NPI | 1598813172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02306100) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS036703) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-12-15 |