| NPI | 1760609739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI14783) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS028214L) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-09 |