| NPI | 1144543554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 6876) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 6876) |
| 1223D0001X Dentist, Dental Public Health (Licence: MD 6876) | |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2019-11-04 |