| NPI | 1629099171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: NC 5497) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 5497) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-12-18 |