| NPI | 1982693354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02061300) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 043968) |
| 122300000X Dentist (Licence: PA DS037417) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2008-03-04 |