| NPI | 1134775067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PA DS042429) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: PA DS042429) |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2023-05-03 |