| NPI | 1528400140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA ds028710l) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds028710l) |
| 1223P0300X Dentist, Periodontics (Licence: PA ds028710l) | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2013-07-24 |