| NPI | 1407931678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA 232510054) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS025588L) |
| 1223G0001X Dentist, General Practice (Licence: PA DS025588L) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2021-03-10 |