| NPI | 1306384631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DA031831) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041141) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2020-07-31 |