| NPI | 1952080251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044245) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02979800) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2023-07-14 |