| NPI | 1376821306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS038851) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: PA DS038851) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2024-09-05 |