| NPI | 1003988064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: UT 272632-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7446) |
| 1223G0001X Dentist, General Practice (Licence: ID D3102) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2012-10-08 |