| NPI | 1851687792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02501300) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037953) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-12-19 |