| NPI | 1528797354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D-0007029-C1) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2023-09-08 |