| NPI | 1902198294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DS045522) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS045522) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2026-09-11 |