| NPI | 1518858984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS045267) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 14053) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-26 |