| NPI | 1609121482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02508900) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039247) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2012-11-11 |