| NPI | 1871698837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS-019943-L) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC 4257) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-03-21 |