| NPI | 1083104988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D15007) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041463) |
| 1223G0001X Dentist, General Practice (Licence: IA DDS-09532) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN22814) | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-02-23 |