| NPI | 1841693645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: VA 0401414639) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 000079-1) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2017-04-20 |