| NPI | 1497716096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 14378) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035239) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS035239) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2013-10-24 |