| NPI | 1033566195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS040789) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040789) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2022-10-06 |