| NPI | 1578509139 |
|---|---|
| Former Name | JOHN WILLIAM GIBSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 034460) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS022006L) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2013-11-13 |