| NPI | 1821126129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS037454) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050954-1) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2010-03-15 |