NPI | 1285311555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS044198) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS044198) |
Enumeration Date | 2023-06-29 |
Last Update Date | 2025-08-03 |