NPI | 1467667105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS027460L) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS027460L) |
Enumeration Date | 2007-05-14 |
Last Update Date | 2022-09-22 |