| NPI | 1588895916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS037961) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037961) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2021-09-30 |