| NPI | 1851602775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA ds038347) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038347) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA ds038347) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2018-01-30 |