| NPI | 1790165702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 100019) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040406) |
| 1223G0001X Dentist, General Practice (Licence: PA DS040406) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-06-18 |