| NPI | 1922172071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS035559L) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS035559) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2009-12-07 |