| NPI | 1720200421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI018407) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PA DS028324L) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2022-04-27 |