| NPI | 1699058305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS038080) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038080) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2014-01-08 |