| NPI | 1891273587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS041812) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34517) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2026-06-09 |