| NPI | 1790418135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AL D.007269-C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 431022) |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2023-12-14 |