| NPI | 1952751950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS042953) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI0263900) |
| 122300000X Dentist (Licence: PA DS042953) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2024-09-17 |