| NPI | 1528249158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: LA P-175) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 2501-89) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2022-06-01 |