| NPI | 1427152594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS021250L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS021250L) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2016-03-15 |