| NPI | 1861968430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS042352) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11013555-9921) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2021-01-05 |