| NPI | 1588891477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 5935) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1294) |
| 122300000X Dentist (Licence: MT DEN-DEN-LIC-5935) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2017-10-29 |