| NPI | 1336306265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PA DS029260L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS029260L) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2024-07-15 |