| NPI | 1992060933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS043376) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 201936) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-08-08 |