| NPI | 1407980527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN.DEN.LIC1964) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 1964 mt) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2023-09-19 |