| NPI | 1760447817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS029742L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI019768) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2011-10-12 |