| NPI | 1033268719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DENDENLIC1266) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 420939448) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2017-01-18 |