| NPI | 1497775092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS040419) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018237) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2015-06-12 |