| NPI | 1205100914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS040431) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62002) |
| 122300000X Dentist (Licence: PA DS040431) | |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2025-07-29 |