| NPI | 1679701734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12191) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037963) |
| 122300000X Dentist (Licence: GA DN015804) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2025-01-14 |