| NPI | 1962176651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12317) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NC 12317) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2021-08-05 |