| NPI | 1932117942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS027053L) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411185) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2017-01-07 |