| NPI | 1649692104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN31095) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039809) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2026-04-14 |