| NPI | 1265623417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS027711L) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PA DS027711L) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2022-04-20 |