| NPI | 1629182993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PA DS036853) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036853) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2018-03-17 |