| NPI | 1326600628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS042333) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042333) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2020-12-02 |