| NPI | 1164901328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042054) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA D042054) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2023-03-22 |