| NPI | 1710291596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009176) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038419) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2025-08-03 |