| NPI | 1740562883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS039272) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055756) |
| 1223G0001X Dentist, General Practice (Licence: CA 60669) | |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2023-11-27 |