| NPI | 1215293196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS038799) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038799) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2022-09-13 |