| NPI | 1639741101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38293) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-21470) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2022-10-31 |