| NPI | 1831628148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 140965) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-13443) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-07-31 |