| NPI | 1730527821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS036476) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 7461) |
| 122300000X Dentist (Licence: DE G1-0000943) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |