| NPI | 1497076079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NE 7303) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: MT 2404) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2017-01-25 |