| NPI | 1972798528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS038681) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI02355900) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2012-07-05 |