| NPI | 1811091317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: VA 0401418306) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN d12189) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401418306) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-08-31 |