| NPI | 1306990155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS029784L) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA 029784) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-07-14 |