| NPI | 1639205743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS037118) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI19811) |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2008-02-05 |