| NPI | 1356517106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS021701L) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN11850) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2008-05-01 |