| NPI | 1821397589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 6404) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL MD.31846) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2022-08-10 |