| NPI | 1013130202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: PA DA031669) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS-021896-L) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-02-11 |