| NPI | 1346500170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009091) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039084) |
| 122300000X Dentist (Licence: MO 2013027107) | |
| Enumeration Date | 2012-05-27 |
| Last Update Date | 2023-01-27 |