| NPI | 1265417935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DA-029713-A) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS 029713 L) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2013-06-06 |