| NPI | 1851838585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS041131) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415489) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2017-02-02 |