| NPI | 1902059041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16724) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DSO36364) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2018-11-27 |