| NPI | 1134612252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-21521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 12275) |
| 1223G0001X Dentist, General Practice (Licence: FL 23469) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN1857985) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2021-08-06 |