| NPI | 1306856356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: CA 100042) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60319) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2018-04-03 |