| NPI | 1407071533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 12571) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS031614L) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |