| NPI | 1538786876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS042786) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN124020) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2026-02-02 |