| NPI | 1699077800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 150818) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NC 9090) |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2024-09-06 |