| NPI | 1477987931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT 13592) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: MT 13592) |
| 1223G0001X Dentist General Practice (Licence: OR D9953) | |
| Enumeration Date | 2013-09-02 |
| Last Update Date | 2020-11-16 |