NPI | 1699763755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS039364) |
Additional Taxonomies | 122300000X Dentist (Licence: WV 3563) |
122300000X Dentist (Licence: SC 4245) | |
Enumeration Date | 2005-10-12 |
Last Update Date | 2013-06-21 |