| NPI | 1881007821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008947) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: AZ 8947) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2018-11-06 |