| NPI | 1366475477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS028179L) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 10306) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2020-12-14 |