| NPI | 1215074695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D.007313-C) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 16096) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2024-06-17 |