| NPI | 1548362304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS038648) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411536) |
| 1223G0001X Dentist, General Practice (Licence: KS 60416) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2012-10-23 |