| NPI | 1356995260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11112) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: OR D11112) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2023-09-06 |