| NPI | 1417176157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME 4101) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS035713) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-02-09 |