| NPI | 1184739773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PA DS026440-L) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: FL DN14014) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |