| NPI | 1992789242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 12490) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS-031221-L) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2025-09-11 |