| NPI | 1013083427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: OR D11436) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5901) |
| 122300000X Dentist (Licence: TX 26305) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2022-05-10 |