| NPI | 1124085261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS020923L) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA DS020923L) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2015-11-19 |