| NPI | 1477034189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS042238) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN27089) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2022-08-03 |