| NPI | 1093042111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: TX 26384) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412678) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2017-02-27 |