| NPI | 1417361833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC7779) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-7779) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2015-03-19 |