| NPI | 1962957951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02639900) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040914) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |