| NPI | 1316210859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-2432) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-REN-3113) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2022-09-21 |