| NPI | 1720602402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042683) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 14276769-9925) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2026-07-31 |