| NPI | 1508982778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: PA DS038647) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038647) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2017-01-06 |