| NPI | 1437510146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MT DEN-DEN-LIC-21366) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-21366) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2021-08-03 |