| NPI | 1518254382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3954) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds039435) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2025-07-31 |