| NPI | 1275798845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS039117) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014209) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2015-06-19 |