| NPI | 1790705614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS037814) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01705500) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-10-24 |