| NPI | 1558097709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-27530) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12939519-9921) |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2024-06-05 |