| NPI | 1275552234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DS025404L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS025404L) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-09-02 |