| NPI | 1649431784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS039542) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD437840) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2015-03-16 |