| NPI | 1821587643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS041896) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7239) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2022-05-13 |