| NPI | 1255318457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS027136L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 10549) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2022-11-30 |