| NPI | 1770153314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D5324) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-21478) |
| 1223G0001X Dentist, General Practice (Licence: OR D11460) | |
| Enumeration Date | 2021-06-27 |
| Last Update Date | 2021-10-27 |