| NPI | 1518997246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS019609-L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS019609L) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2015-08-13 |