| NPI | 1114986700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D.0006718-C) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 004497) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2019-11-25 |