| NPI | 1952582454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS040706) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02442600) |
| 122300000X Dentist (Licence: NE 6737) | |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2019-04-24 |