| NPI | 1902142615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02528700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039411) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2019-03-04 |