| NPI | 1386662625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS025311L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS025311L) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-04-26 |