| NPI | 1548246481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DS023405L) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: HI DT2553) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2014-08-15 |