| NPI | 1780608620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS035409) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS035409) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |