| NPI | 1437590593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-13422) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4511) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60476566) | |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2018-04-23 |