| NPI | 1518308584 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-25871) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS03944) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2024-08-15 |