| NPI | 1629091244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001186) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS 029796L) |
| 122300000X Dentist (Licence: MD 14747) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2012-11-30 |