| NPI | 1891838595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18197) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS-022535-L) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI01393900) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2016-02-02 |