| NPI | 1992124523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02622400) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040441) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2024-09-09 |