| NPI | 1306689245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40432) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS045552) |
| 122300000X Dentist (Licence: OH 30.028312) | |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2026-04-01 |