| NPI | 1609227982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS040880) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040880) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2025-07-22 |