| NPI | 1265975312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: TX 33470) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 33470) |
| 1223G0001X Dentist General Practice (Licence: TX 33470) | |
| 1223G0001X Dentist General Practice (Licence: MA DL12935) | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2024-07-26 |