| NPI | 1619179702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22D02270601) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS035257) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2019-02-21 |