| NPI | 1386404812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044613) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS044613) |
| 125Q00000X Oral Medicine (Licence: PA DS044613) | |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2026-06-23 |