| NPI | 1720312978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0411000033) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ Dio16285) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2009-09-21 |