| NPI | 1073122362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MO 2020022878) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2020022878) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2020-07-23 |