| NPI | 1013110667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS013521L) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS013521L) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2007-07-08 |