| NPI | 1750012472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044181) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 18404) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2025-03-25 |