| NPI | 1558482133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: OR D10947) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: AZ 6106) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2019-03-05 |