| NPI | 1558720094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS042513) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA RFD000017) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2021-03-16 |