| NPI | 1710276910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0001304) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038554) |
| 122300000X Dentist (Licence: NJ 22DI02472500) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2016-03-30 |