| NPI | 1336989151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS045615) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC DGD10853) |
| 1223G0001X Dentist, General Practice (Licence: NC 14027) | |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2026-08-31 |