| NPI | 1942412374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS026720L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 42445) |
| 1223G0001X Dentist, General Practice (Licence: NJ 17029) | |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2007-07-08 |