| NPI | 1215035084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA 026351) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA BR1727215) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |