| NPI | 1184780421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: MT 1481) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MT 1481) |
| 208D00000X General Practice (Licence: MT 4090) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2023-03-07 |