| NPI | 1508358953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 4340) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS042611) |
| 1223G0001X Dentist, General Practice (Licence: MD 17003) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2022-08-19 |