| NPI | 1780660803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22di017432) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038225) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2010-05-03 |