| NPI | 1841920618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02910800) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043606) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-09-16 |