| NPI | 1881797959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS025465L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 9430) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-03-02 |