| NPI | 1144775412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT DEN-DEN-LIC-13444) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AK 112730) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2022-07-21 |