| NPI | 1740281724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA ds-028464-l) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 12911) |
| 125Q00000X Oral Medicinist (Licence: PA DS-028464-L) | |
| 1223G0001X Dentist, General Practice (Licence: MS 3019-97) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2023-08-28 |