| NPI | 1871716167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS44352) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 4986) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2025-01-15 |