| NPI | 1548338767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-28426) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV SD1319) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2024-06-24 |