| NPI | 1437193372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DA-021214-A) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: SC 8828) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2017-04-05 |