| NPI | 1881362291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS043368) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI2864700) |
| 122300000X Dentist (Licence: KY 10689) | |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2024-03-20 |