| NPI | 1326026527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1001775-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035790) |
| 1223G0001X Dentist, General Practice (Licence: DC den1000478) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2018-04-23 |