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 |