| NPI | 1477113975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: NC 11429) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 11429) |
| 1223G0001X Dentist, General Practice (Licence: NC 11429) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-02-06 |