| NPI | 1669782355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D008098) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038607) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2016-01-15 |