| NPI | 1083238869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS043048) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 12250) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-09-04 |