| NPI | 1407249410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS039957) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039957) |
| 1223G0001X Dentist, General Practice (Licence: PA DS039957) | |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2023-08-03 |