| NPI | 1740477553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI02264100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058926) |
| 1223G0001X Dentist, General Practice (Licence: PA DS035642) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2018-03-17 |