| NPI | 1265883573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS040774) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA Notification of Post) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2017-03-27 |