| NPI | 1376727891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS030054L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 0554499) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2021-10-02 |