| NPI | 1952963787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13873) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042312) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-07-21 |