| NPI | 1912433988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS045086) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D14231) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-05-14 |