| NPI | 1821258336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS041780) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 036156) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2019-12-10 |