| NPI | 1952650731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS 039154) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22 DI 02511200) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2014-07-28 |