| NPI | 1134771207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12193) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS042275) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2022-11-08 |