| NPI | 1750548905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2001030601) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: MO 2001030601) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2023-03-30 |