| NPI | 1720372725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: TX 27272) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19353) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2017-03-06 |