| NPI | 1760436729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS0000008290) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036077) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2023-03-07 |