| NPI | 1043441108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DS038003) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS38003) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2018-10-19 |