| NPI | 1841744455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PA DS040856) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS040856) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2019-09-12 |