| NPI | 1114059094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS037590) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9534) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2025-07-10 |