| NPI | 1013193598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 2569) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS022084L) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2010-11-01 |