| NPI | 1225057029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MO 2020022988) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 19572) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-07-30 |