| NPI | 1033404132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8164) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038735) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2023-01-23 |