| NPI | 1871807172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA PA DS 038484) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: OK 6252) | |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2012-03-07 |