| NPI | 1760575377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS021080L) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC012509) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-12 |