| NPI | 1457560641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS-035937) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DSO35937) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-03-23 |