| NPI | 1295703387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS035547) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035547) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-03-14 |