| NPI | 1124604038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS043433) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 4518) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2023-12-13 |