| NPI | 1861525065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 161552) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043472) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-02-01 |