| NPI | 1326165168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: GA DN014347) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 15111) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2019-01-11 |