| NPI | 1942866280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS043969) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 061697) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2023-12-28 |