| NPI | 1013003268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 7848) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1145) |
| 1223D0001X Dentist, Dental Public Health (Licence: AK 1145) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2009-08-20 |