| NPI | 1386924793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MT DEN-DEN-LIC-20068) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-20068) |
| 122300000X Dentist (Licence: AZ 8252) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2024-04-24 |