| NPI | 1245246651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS023954L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 34714) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-03-01 |