| NPI | 1629385638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS021310L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS021310L) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2020-12-30 |