| NPI | 1790918837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 04359) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038001) |
| 1223G0001X Dentist, General Practice (Licence: NY 057804) | |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02435900) | |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2019-06-10 |