| NPI | 1659636736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: NC 10292) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10292) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2019-08-19 |