| NPI | 1730392457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044965) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 038745) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2026-03-30 |