| NPI | 1376513242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11139) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS027984L) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-03-07 |