| NPI | 1205377355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA 37580) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041332) |
| 122300000X Dentist (Licence: TX 37580) | |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2024-07-01 |