| NPI | 1952375065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS036669) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60529) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2008-04-14 |