| NPI | 1538903620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 18439) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS044734) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2025-05-15 |