| NPI | 1497410658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS045232) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA RFD000048) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-10-14 |