| NPI | 1033187729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044943) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 14897) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-02-04 |