| NPI | 1972615615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02305200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037373) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-02-26 |