| NPI | 1518578822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 19394) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-19394) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-08-19 |