| NPI | 1932129012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9247) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS-030099-L) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-03-12 |