| NPI | 1235971060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS045346) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5637) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-07-26 |