| NPI | 1245455914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3677) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-10-10 |