| NPI | 1619039336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS026092L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA PADS026092-L) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2021-08-04 |