| NPI | 1427221688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: MO 014675) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 014675) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2013-03-04 |