| NPI | 1023310729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-22312) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4292) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2022-06-23 |