| NPI | 1164648903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 6900) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NC 6900) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2024-03-21 |