| NPI | 1134380165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS041604) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 12901) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2026-01-22 |