| NPI | 1003012212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN22364) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS031205L) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2017-02-21 |