| NPI | 1134113657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 11504) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9527884-9922) |
| 1223G0001X Dentist, General Practice (Licence: MT Den-Den-Lic-11504) | |
| 1223G0001X Dentist, General Practice (Licence: FL dn 16868) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2021-08-24 |