| NPI | 1710090576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DS035742) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS035742) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-04-22 |