| NPI | 1477980605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT DEN-DEN-LIC-5992) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D-4498) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2014-08-14 |