| NPI | 1902067556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DIO25025200) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037543) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2015-04-28 |