| NPI | 1730270257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WV 2703) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS023559L) |
| 1223G0001X Dentist General Practice (Licence: FL DN 10380) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2015-05-05 |