| NPI | 1174734263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS024907L) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS 024907-L) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2010-02-19 |