| NPI | 1669631784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN14654) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS026309L) |
| 122300000X Dentist (Licence: IL 019024659) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2019-03-17 |