| NPI | 1821658667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: LA DEN4721) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04494) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2023-07-26 |