| NPI | 1639502818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 17402) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039722) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2022-12-19 |